BACKGROUND: Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. METHODS AND MATERIALS: Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. RESULTS: The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. CONCLUSION: Hypofractionated PBT to the thorax delivered over 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.
BACKGROUND: Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. METHODS AND MATERIALS: Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. RESULTS: The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. CONCLUSION: Hypofractionated PBT to the thorax delivered over 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.
Authors: Kenneth E Rosenzweig; Jana L Fox; Ellen Yorke; Howard Amols; Andrew Jackson; Valerie Rusch; Mark G Kris; Clif C Ling; Steven A Leibel Journal: Cancer Date: 2005-05-15 Impact factor: 6.860
Authors: Yixiu Kang; Xiaodong Zhang; Joe Y Chang; He Wang; Xiong Wei; Zhongxing Liao; Ritsuko Komaki; James D Cox; Peter A Balter; Helen Liu; X Ronald Zhu; Radhe Mohan; Lei Dong Journal: Int J Radiat Oncol Biol Phys Date: 2007-03-01 Impact factor: 7.038
Authors: Corey J Langer; Judith Manola; Patricia Bernardo; John W Kugler; Philip Bonomi; David Cella; David H Johnson Journal: J Natl Cancer Inst Date: 2002-02-06 Impact factor: 13.506
Authors: Joe Y Chang; Heng Li; X Ronald Zhu; Zhongxing Liao; Lina Zhao; Amy Liu; Yupeng Li; Narayan Sahoo; Falk Poenisch; Daniel R Gomez; Richard Wu; Michael Gillin; Xiaodong Zhang Journal: Int J Radiat Oncol Biol Phys Date: 2014-09-24 Impact factor: 7.038
Authors: Puneeth Iyengar; Elizabeth Zhang-Velten; Laurence Court; Kenneth Westover; Yulong Yan; Mu-Han Lin; Zhenyu Xiong; Mehul Patel; Douglas Rivera; Joe Chang; Mark Saunders; Anand Shivnani; Andrew Lee; Randall Hughes; David Gerber; Jonathan Dowell; Ang Gao; John Heinzerling; Ying Li; Chul Ahn; Hak Choy; Robert Timmerman Journal: JAMA Oncol Date: 2021-10-01 Impact factor: 33.006